In
patients with radiculopathy due to cervical disc disease, anterior cervical
decompression and fusion (ACDF) followed by physical therapy did not result in
additional improvements in neck active range of motion, neck muscle endurance,
or hand-related function compared with a structured physical therapy program
alone, say authors of an article published this
month in Spine. They suggest that a
structured physical therapy program should precede a decision for ACDF
intervention in patients with radiculopathy to reduce the need for surgery.

In
this prospective randomized study, 63 patients with radiculopathy and magnetic
resonance imaging-verified nerve root compression received either ACDF in
combination with physical therapy or physical therapy alone. Outcomes,
including active range of neck motion, neck muscle endurance, and hand-related
functioning, were measured in 49 of these patients by an independent examiner
before treatment and at 3-, 6-, 12-, and 24-month follow-ups.

There
were no significant differences between the 2 treatment alternatives in any of
the measurements performed. Both groups showed improvements over time in neck
muscle endurance, manual dexterity, and right-handgrip strength.

Comments

I think pain level (NPRS)would have been a useful criteria for the outcome study.
Also instead of R handed grip strength, I think either dominant hand grip strength or hand grip on the side that was most painful/affected would have been more informative.

Posted by Ellen Kohler PT, OCS
on 2/22/2013 11:59 PM

Pain level and parasthesia parameters need to be studied and compared. Nerve root compression pain can be unbareable and often why patients opt for ACDF surgery,

Posted by Carolyn
on 2/23/2013 7:26 AM

I always make clear to patients considering fusion
(or total joint arthroscopy for that matter)that the procedure is not intended to improve ROM. So why in this study was
this be used as an outcome measurement?

Posted by Kim
on 2/24/2013 8:15 AM

How could they choose NOT to look at pain levels? If this article showed no benefit for the parameters they listed and showed no difference for pain levels, it would make a strong case for avoiding surgery. But, pain is the number one reason people seek surgery in the first place. The pain has to be investigated.

Posted by Ken Johnson, PT
on 2/26/2013 9:05 AM

I would love to do this same study with treatment that includes both treatment of the nerves and dura (a la Jean Pierre Barral, PT, DO and Alain Crobier, DO) and use of Shirley Sahrmann's techniques for addressing the mechanical contributing factors. I have found this combination very effective in this or any other painful cervical spine diagnoses.